Rapid diagnostic tests for infectious diseases in the emergency department

Bouzid, Donia; Zanella, Marie-Céline; Kerneis, Solen; Visseaux, Benoît; May, Larissa; Schrenzel, Jacques; Cattoir, Vincent

BACKGROUND: Rapid diagnostic tests (RDTs) for infectious diseases, with a turn-around time <2 hours, are promising tools that could improve patient care, antimicrobial stewardship and infection prevention in the emergency department (ED) setting. Numerous RDTs have been developed but not necessarily for the ED environment. Their successful implementation in the ED relies on their performance and impact on patient management. OBJECTIVES: The aim of this narrative review is to provide an overview of currently available RDTs for infectious diseases in the ED. SOURCES: PubMed was searched through August 2019 for available studies on RDTs for infectious diseases. Inclusion criteria included: commercial tests approved by the FDA or CE-IVD with data on clinical samples, ability to run on fully-automated systems and result delivery within 2 hours. CONTENT: A non-exhaustive list of representative commercially available FDA or CE approved assays was categorized by clinical syndrome: pharyngitis and upper respiratory tract infection, lower respiratory tract infection, gastrointestinal infection, meningitis and encephalitis, fever in the returning traveler and sexually-transmitted infection including HIV. The performance of tests was described based on clinical validation studies. Further, their impact on clinical outcomes and anti-infective use was discussed with a focus on ED-based studies. IMPLICATIONS: Clinicians should be familiar with the distinctive features of each RDT and individual performance characteristics for each target. Their integration into ED workflow should be pre-planned considering local constraints of given settings. Additional clinical studies are needed to further evaluate their clinical and cost effectiveness.